Citation Nr: 0905607
Decision Date: 02/17/09 Archive Date: 02/24/09
DOCKET NO. 07-11 663 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Montgomery,
Alabama
THE ISSUES
1. Entitlement to service connection for diabetes mellitus,
to include as secondary to herbicide exposure.
2. Entitlement to service connection for erectile
dysfunction.
3. Entitlement to service connection for hearing loss.
4. Entitlement to service connection for tinnitus.
5. Entitlement to service connection for arthritis of the
bilateral hips, claimed as bone loss of the right and left
hip.
6. Entitlement to service connection for arthritis of the
bilateral knees, claimed as bone loss of the right and left
leg.
7. Entitlement to service connection for neuropathy of the
right and left hand.
8. Entitlement to service connection for sleep apnea.
9. Entitlement to service connection for post-traumatic
stress disorder (PTSD).
REPRESENTATION
Appellant represented by: Alabama Department of Veterans
Affairs
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
L. Kirscher Strauss, Associate Counsel
INTRODUCTION
The Veteran served on active military service from January
1967 to January 1969.
This matter comes before the Board of Veterans' Appeals
(Board) from a rating decision dated in August 2005 by the
Montgomery, Alabama Regional Office (RO) of the Department of
Veterans Affairs (VA), which denied service connection for
diabetes mellitus, to include as secondary to herbicide
exposure; erectile dysfunction; hearing loss; tinnitus;
arthritis of the bilateral hips, claimed as bone loss of the
right and left hip; arthritis of the bilateral knees, claimed
as bone loss of the right and left leg; neuropathy of the
right and left hand; sleep apnea; and PTSD.
In November 2008, the Veteran testified at a hearing before
RO personnel; a transcript of the hearing is of record. The
record was held open for 60 days for the Veteran to submit
private treatment records.
In November 2008, the Veteran submitted to the Board
additional evidence for consideration in connection with the
hearing loss, arthritis of the bilateral hips and bilateral
knees, and sleep apnea claims on appeal. A waiver of RO
jurisdiction for this evidence was received in a written
statement dated in November 2008 that is included in the
record. The Board accepts this evidence for inclusion in the
record on appeal. See 38 C.F.R. § 20.1304 (2008).
FINDINGS OF FACT
1. All notification and development action needed to fairly
adjudicate each claim on appeal has been accomplished.
2. On November 19, 2008, prior to the promulgation of a
decision in the appeal, the Board received notification from
the appellant that a withdrawal of the appeal as to service
connection for diabetes mellitus and erectile dysfunction is
requested.
3. The Veteran currently has bilateral hearing loss to an
extent recognized as a disability for VA purposes.
4. Although the Veteran may well have experienced in-service
noise exposure as alleged, the record contains no competent
opinion addressing the question of whether there exists a
medical nexus between any in-service noise exposure and
current bilateral hearing loss, and the evidence addressing
his pre- and post-service occupational noise exposure weighs
against the claim.
5. Tinnitus is not shown to be due to exposure to acoustic
trauma during military service.
6. Arthritis of the bilateral hips was first shown many
years after separation from service, and is not shown to be
related to events, disease, or injury during military
service.
7. Arthritis of the bilateral knees was first shown many
years after separation from service, and is not shown to be
related to events, disease, or injury during military
service.
8. The Veteran is not shown to have a current neuropathy
disability of the right or left hand for VA compensation
purposes.
9. Sleep apnea was first shown many years after separation
from service and is not shown to have been the result of
events, disease, or injury during military service.
10. The Veteran is not shown to have a current PTSD
disability as a result of events during military service.
CONCLUSIONS OF LAW
1. The criteria for withdrawal of a Substantive Appeal for
the issue of service connection for diabetes mellitus by the
appellant have been met. 38 U.S.C.A. § 7105(b)(2), (d)(5)
(West 2002); 38 C.F.R. §§ 20.202, 20.204 (2008).
2. The criteria for withdrawal of a Substantive Appeal for
the issue of service connection for erectile dysfunction by
the appellant have been met. 38 U.S.C.A. § 7105(b)(2),
(d)(5) (West 2002); 38 C.F.R. §§ 20.202, 20.204 (2008).
3. Hearing loss was not incurred in or aggravated by
military service, nor may service incurrence of an organic
disease of the nervous system (sensorineural hearing loss) be
so presumed. 38 C.F.R. §§ 1110, 1154(b), 5103, 5103A, 5107
(West 2002 & Supp. 2006); 38 C.F.R. §§ 3.102, 3.159, 3.303,
3.385 (2008).
4. Tinnitus was not incurred in or aggravated by military
service, nor may service incurrence of an organic disease of
the nervous system be presumed. 38 U.S.C.A. §§ 1101, 1110,
1112, 1113, 5103(a), 5103A (West 2002 & Supp. 2006); 38
C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2008).
5. Arthritis of the bilateral hips was not incurred in or
aggravated by military service, nor may service incurrence of
arthritis of the bilateral hips be presumed. 38 U.S.C.A. §§
1101, 1110, 1112, 1113, 5103(a), 5103A (West 2002 & Supp.
2006); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2008).
6. Arthritis of the bilateral knees was not incurred in or
aggravated by military service, nor may service incurrence of
arthritis of the bilateral knees be presumed. 38 U.S.C.A. §§
1101, 1110, 1112, 1113, 5103(a), 5103A (West 2002 & Supp.
2006); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2008).
7. Neuropathy of the right and left hand was not incurred in
or aggravated by military service. 38 U.S.C.A. §§ 1110,
1131, 5107 (West 2002 & Supp. 2007); 38 C.F.R. § 3.303
(2008).
8. Sleep apnea was not incurred in or aggravated by military
service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002 & Supp.
2007); 38 C.F.R. § 3.303 (2008).
9. PTSD was not incurred in or aggravated by active military
service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West
2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 4.125 (2008).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
VCAA
The provisions of the Veterans Claims Assistance Act of 2000
(VCAA), codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159,
3.326(a), and as interpreted by the United States Court of
Appeals for Veterans Claims (the Court) have been fulfilled.
In this case, the Veteran's claims for service connection for
hearing loss; tinnitus; arthritis of the bilateral hips,
claimed as bone loss of the right and left hip; arthritis of
the bilateral knees, claimed as bone loss of the right and
left leg; neuropathy of the right and left hand; sleep apnea;
and PTSD were received in February 2005. Thereafter, he was
notified of the provisions of the VCAA by the RO in
correspondence dated in March 2005. This letter notified the
Veteran of VA's responsibilities in obtaining information to
assist the Veteran in completing his claims, identified the
Veteran's duties in obtaining information and evidence to
substantiate his claims, and provided other pertinent
information regarding the VCAA. Thereafter, the claims were
reviewed and a statement of the case was issued in March
2007. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a),
Quartuccio v. Principi, 16 Vet. App. 183 (2002), Pelegrini v.
Principi, 18 Vet. App. 112 (2004). See also Mayfield v.
Nicholson, 19 Vet. App. 103, 110 (2005), reversed on other
grounds, 444 F.3d 1328 (Fed. Cir. 2006); Mayfield v.
Nicholson (Mayfield II), 20 Vet. App. 537 (2006); Kent v.
Nicholson, 20 Vet. App. 1 (2006), Mayfield v. Nicholson
(Mayfield III), 07-7130 (Fed. Cir. September 17, 2007).
During the pendency of this appeal, the Court in Dingess v.
Nicholson, 19 Vet. App. 473 (2006), found that the VCAA
notice requirements applied to all elements of a claim. An
additional notice as to this matter was provided in July
2006.
The Veteran has been made aware of the information and
evidence necessary to substantiate his claims and has been
provided opportunities to submit such evidence. A review of
the claims file also shows that VA has conducted reasonable
efforts to assist him in obtaining evidence necessary to
substantiate his claims during the course of this appeal.
His service treatment records, service personnel records, and
private treatment records pertaining to his claimed
disabilities have been obtained and associated with his
claims file.
The Veteran was not provided a VA medical examination and
opinion to assess the current nature and etiology of any of
his claimed disabilities. However, VA need not conduct an
examination with respect to these claims on appeal, as
information and evidence of record contains sufficient
competent medical evidence to decide the claims. See 38
C.F.R. § 3.159(c)(4) (2008). Under McLendon v. Nicholson, 20
Vet. App. 79 (2006), in disability compensation (service
connection) claims, the VA must provide a VA medical
examination when there is (1) competent evidence of a current
disability or persistent or recurrent symptoms of a
disability, and (2) evidence establishing that an event,
injury, or disease occurred in service or establishing
certain diseases manifesting during an applicable presumptive
period for which the claimant qualifies, and (3) an
indication that the disability or persistent or recurrent
symptoms of a disability may be associated with the Veteran's
service or with another service-connected disability, but (4)
insufficient competent medical evidence on file for the VA to
make a decision on the claim.
Simply stated, the standards of McLendon are not met in this
case. With respect to the Veteran's claimed tinnitus,
neuropathy of the right and left hand, and PTSD disabilities,
there is no evidence of a current diagnosis or persistent or
recurrent symptoms of any of these disabilities. Regarding
his hearing loss, sleep apnea, and arthritis of the hips and
knees, although there is evidence of current disability or
symptoms, there is no indication that these claimed
disabilities occurred in service or may be associated with
his service. Therefore, a VA examination to evaluate these
claimed disabilities is not warranted.
Furthermore, the Veteran has not identified any additional,
relevant evidence that has not otherwise been requested or
obtained. The Veteran has been notified of the evidence and
information necessary to substantiate his claims, and he has
been notified of VA's efforts to assist him. See Quartuccio
v. Principi, 16 Vet. App. 183 (2002). As a result of the
development that has been undertaken, there is no reasonable
possibility that further assistance will aid in
substantiating his claims.
Service Connection for Diabetes Mellitus and Erectile
Dysfunction
Under 38 U.S.C.A. § 7105, the Board may dismiss any appeal
which fails to allege specific error of fact or law in the
determination being appealed. A Substantive Appeal may be
withdrawn in writing at any time before the Board promulgates
a decision. 38 C.F.R. § 20.202 (2008). Withdrawal may be
made by the appellant or by his or her authorized
representative. 38 C.F.R. § 20.204 (2008). On November 19,
2008, the appellant withdrew the appeals concerning service
connection for diabetes mellitus and erectile dysfunction,
and, hence, there remain no allegations of errors of fact or
law for appellate consideration. Accordingly, the Board does
not have jurisdiction to review the appeals and they are
dismissed.
General Law and Regulations-Service Connection
Service connection may be granted for disability resulting
from disease or injury incurred in or aggravated by active
military service. See 38 U.S.C.A. §§ 1110, 1131 (West 2002);
38 C.F.R. § 3.303 (2008). Service connection may be
established for any disease diagnosed after discharge, when
all the evidence, including that pertinent to service,
establishes the disease was incurred in service. See 38
C.F.R. § 3.303(d) (2008).
Service connection shall be granted to a Veteran if the
Veteran served 90 days or more during a war period or after
December 31, 1946 or had peacetime service on or after
January 1, 1947, and an organic disease of the nervous system
(sensorineural hearing loss), and/or degenerative arthritis,
although not otherwise established as incurred in or
aggravated by service, is manifested to a compensable degree
within one year following the requisite service. 38 C.F.R.
§§ 3.307, 3.309 (2006)
As a general matter, service connection for a disability on
the basis of the merits of such claim is focused upon (1) the
existence of a current disability, (2) the existence of the
disease or injury in service, and (3) a relationship or nexus
between the current disability and any injury or disease
during service. See Cuevas v. Principi, 3 Vet. App. 542
(1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992).
Service connection for PTSD requires medical evidence
establishing a diagnosis of the condition in accordance with
38 C.F.R. § 4.125(a) (2008); a link, established by medical
evidence, between current symptomatology and an in-service
stressor; and credible supporting evidence that the claimed
in-service stressor actually occurred. If the evidence
establishes that the Veteran engaged in combat with the enemy
and the claimed stressor is related to that combat, in the
absence of clear and convincing evidence to the contrary, and
provided that the claimed stressor is consistent with the
circumstances, conditions, or hardships of the Veteran's
service, the Veteran's lay testimony alone may establish the
occurrence of the claimed in-service stressor. See 38 C.F.R.
§ 3.304(f) (2008).
If the Veteran did not engage in combat with the enemy, his
own testimony by itself is not sufficient to establish the
incurrence of a stressor; rather, there must be service
records or other credible supporting evidence to corroborate
his testimony. See Zarycki v. Brown, 6 Vet. App. 91 (1993);
Doran v. Brown, 6 Vet. App. 283 (1994).
For the purposes of applying the laws administered by VA,
impaired hearing will be considered to be a disability when
the auditory threshold in any of the frequencies 500, 1000,
2000, 3000, 4000 Hertz is 40 decibels or greater; or when the
auditory thresholds for at least three of the frequencies
500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or
greater; or when speech recognition scores using the Maryland
CNC Test are less than 94 percent. See 38 C.F.R. §3.385
(2008).
The Board points out, however, that the absence of in-service
evidence of hearing loss is not fatal to a claim for service
connection. See Ledford v. Derwinski, 3 Vet. App. 87, 89
(1992). Evidence of a current hearing loss disability (i.e.,
one meeting the requirements of 38 C.F.R. § 3.385, as noted
above) and a medically sound basis for attributing such
disability to service may serve as a basis for a grant of
service connection for hearing loss. See Hensley v. Brown, 5
Vet. App. 155, 159 (1993).
To establish service connection for tinnitus, the Veteran is
not obliged to show that his tinnitus was present during
active military service. However, if there is insufficient
evidence to establish that a claimed chronic disability was
present during service, the evidence must establish a nexus
between his current disability and his in-service exposure to
loud noise. See Godfrey v. Derwinski, 2 Vet. App. 352
(1992).
In addition, a Veteran is entitled to a presumption of
service connection if he is diagnosed with certain enumerated
diseases associated with exposure to certain herbicide
agents. See 38 C.F.R. §§ 3.307, 3.309 (2008); 38 U.S.C.A. §
1116 (West 2002 & Supp. 2006). A Veteran who, during active
military, naval, or air service, served in the Republic of
Vietnam during the period beginning on January 9, 1962, and
ending on May 7, 1975 shall be presumed to have been exposed
during such service to an herbicide agent, unless there is
affirmative evidence to establish that the Veteran was not
exposed to any such agent during that service.
In a claim for service connection, the ultimate credibility
or weight to be accorded evidence must be determined as a
question of fact. The Board determines whether (1) the
weight of the evidence supports the claim, or (2) the weight
of the "positive" evidence in favor of the claim is in
relative balance with the weight of the "negative" evidence
against the claim; the appellant prevails in either event.
However, if the weight of the evidence is against the
appellant's claim, the claim must be denied. See 38 U.S.C.A.
§ 5107(b) (West 2002); 38 C.F.R. § 3.102 (2008); Gilbert v.
Derwinski, 1 Vet. App. 49 (1990).
Factual Background and Analysis
The Veteran's service personnel records reflected that his
military service included service in Vietnam from May 1968 to
January 1969. Awarded medals included the Vietnam Service
Medal (VSM) and Vietnam Campaign Medal (VCM). His military
occupational specialty was listed as carpenter.
Hearing Loss and Tinnitus
The Veteran contends that he has hearing loss and tinnitus as
a result of noise exposure from large generators while
working as a carpenter during service.
Service personnel records note that prior to service, the
Veteran was employed for nine months as an auxiliary
equipment operator at a power plant where he ran auxiliary
steam equipment.
During service, the Veteran underwent two pre-induction
audiometric examinations. It should be noted that prior to
November 1967, service departments used ASA units to record
puretone sensitivity thresholds in audiometric measurement.
VA currently uses ISO (ANSI) units. For purposes of
comparison between the service audiometric data and more
recent VA audiometric data, the table below shows the ASA
measurements recorded in service, with the comparable ISO
(ANSI) measurements in adjacent parentheses. The results are
recorded as follows:
HERTZ
Date
Ear
500
1000
2000
3000
4000
Add
(15)
(10)
(10)
(10)
(5)
July 1965
RIGHT
15 (30)
15 (25)
15 (25)
*
*
LEFT
15 (30)
15 (20)
15 (25)
*
*
October
1966
RIGHT
20 (35)
5 (15)
0 (10)
5 (15)
10 (15)
LEFT
15 (30)
5 (15)
0 (10)
15 (25)
45 (50)
*The July 1965 audiometric examination lists results of
"15" for the right and left ear; however, the number is
divided by the vertical line separating the 3000 and 4000
Hertz columns. Nevertheless, whether the examiner intended
to list 15 (25) for each ear under 3000 Hertz, or 15 (20) for
each ear for 4000 Hertz, the results of the July 1965
examination do not equate to impaired hearing for VA
purposes.
In the October 1966 pre-induction Report of Medical History,
the Veteran related that his usual occupation was auxiliary
equipment operator. His service treatment records contained
no complaints or findings of tinnitus.
An Employee Audio History Report from April 1974 to September
2004 from Southern Company reflects impaired hearing for VA
purposes in the left ear from at least April 1974 and in the
right ear from at least December 1985.
In November 2008, the Veteran testified that he began working
as a laborer in April 1966 at Southern Company, which was
previously called Alabama Power, and returned there after
service to work in operations and maintenance on generators
from February 1969 until January 2006. He testified that the
company had foam ear plugs, but did not have mandatory
hearing protection until the 1970s when the Occupational
Safety and Health Administration (OSHA) began to regulate
workplaces. He also testified that his job was very noisy
and that he first noticed ringing in his ears in the mid-
1970s.
The Board has considered the Veteran's claims for service
connection for hearing loss and tinnitus, but finds that they
are not warranted because there is no evidence of hearing
loss or tinnitus in service, nor is there any basis for
attributing such disability to service. Rather, the Veteran
presented evidence that he worked for nine months prior to
service in a very noisy occupational environment without
hearing protection and returned to the same company after
service where he again worked without hearing protection
until the 1970s. Significantly, signs of a hearing loss in
the left ear at 4000Hz were noted during the October 1966
audiometric examination. The record includes no medical
evidence showing complaints or treatment for hearing loss or
tinnitus, and it includes no competent medical opinion
establishing a medical relationship between his claimed
hearing loss and tinnitus disabilities to any established in-
service noise exposure or disease, and neither the Veteran
nor his representative has presented, identified, or alluded
to the existence of any such opinion. Without medical
evidence of a nexus between a claimed in-service disease or
injury and the present disease or injury, service connection
cannot be granted on a direct basis. See Hickson v. West, 12
Vet. App. 247, 253 (1999). The claims for service connection
for hearing loss and tinnitus must be denied.
Arthritis of the Bilateral Hips and Bilateral Knees
The Veteran contends that he has arthritis of the bilateral
hips and bilateral knees as a result of doing construction
work with heavy two-by-four and two-by-six oak beams during
military service.
Service treatment records are entirely silent for any
complaints, findings or reference to the hips and knees.
A statement from Chelsea Family Medicine dated in July 2005
indicated that the Veteran has severe osteoarthritic disease
in both hips, and a statement from St. Vincent's Orthopedics,
P.C., dated in March 2006 reported that he has bilateral hip
and knee arthritis.
In November 2008, the Veteran testified that he was diagnosed
with arthritis in his knees in the mid-1990s and in his hips
around 2000. He also testified that he was awarded
disability benefits from the Social Security Administration
(SSA) in July 2006 based on arthritis in his hips and knees,
and that he had a quintuple-bypass surgery in February 2006,
within days after his last day of work in January 2006.
When the record suggests that SSA may have records pertinent
to the appellant's claim, but which have not been obtained,
either a remand is required to obtain the records, or a non-
conclusory explanation needs to be provided as to why the SSA
records would have no reasonable possibility of
substantiating the claim. See 38 U.S.C.A. §§ 5103A(a),
5103A(b)(1), 7104(d)(1). The Board finds that the SSA
records are not required to decide the Veteran's claims for
service connection for arthritis of his bilateral hips and
bilateral knees because he testified that the earliest he was
diagnosed with either disability was in the mid-1990s,
approximately 25 years after separation from service, and the
first medical diagnosis of arthritis is documented in 2005.
The passage of many years between discharge from active
service and the medical documentation of a claimed disability
may be considered evidence against a claim of service
connection. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir.
2000); Shaw v. Principi, 3 Vet. App. 365 (1992).
Additionally, no competent evidence of record provides a link
between the Veteran's arthritis disabilities and his active
service. Without medical evidence of a nexus between a
claimed in-service disease or injury and the present disease
or injury, service connection cannot be granted on a direct
basis. Hickson v. West, 12 Vet. App. 247, 253 (1999).
Neuropathy of the Right and Left Hand
Service treatment records are entirely silent for any
complaints, findings or reference to the hands. The
Veteran's claims file contains no evidence that he has
current neuropathy of the right and left hand, to include as
secondary to his claimed diabetes mellitus disability. In
November 2008, he testified that he believed his neuropathy
of the right and left hand was the result of exposure to
Agent Orange (herbicides) and that he would submit medical
documentation of his claimed disability. As agreed, the file
was held open for 60 days, in order that the Veteran could
submit evidence. No additional medical evidence was
received, however. Therefore, his claim for service
connection for neuropathy of the right and left hand must be
denied because there is no evidence of a current disability.
See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).
Sleep apnea
Service treatment records are entirely silent for any
complaints, findings or reference to sleep apnea. At the
time of his separation from service, he was noted to be 6-
feet tall, and weighed 200 pounds.
A patient information and delivery form from Precision CPAP,
Inc. dated in February 2007 lists a diagnosis of OSA
(obstructive sleep apnea).
In November 2008, the Veteran testified that his sleep
pattern during service was disturbed by having to pour
concrete for 24 hours or by waking to an attack on the
compound. He testified that his wife first noticed a problem
with his sleep when he first returned from service, but he
did not seek treatment for his sleep disorder until the mid-
1980s. He further testified that at one point he weighed
over 300 pounds and that a doctor had suggested to him that
his weight was related to his sleep problems. He added that
he got down to 230 pounds, but still had sleep apnea.
The Board has considered the Veteran's claim for service
connection for sleep apnea, but finds that it is not
warranted because there is no connection between his current
sleep disorder and any event, injury, or disease in service.
Here, the first evidence of sleep apnea is the February 2007
delivery form from Precision CPAP, Inc., more than 38 years
after separation from service. The passage of many years
between discharge from active service and the medical
documentation of a claimed disability may be considered
evidence against a claim of service connection. Maxson v.
Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000); Shaw v.
Principi, 3 Vet. App. 365 (1992). Additionally, no competent
evidence of record provides a link between the Veteran's
sleep apnea and his active service. On the contrary, the
Veteran's own testimony provides a link between his reported
excess weight and his current sleep apnea. Without medical
evidence of a nexus between a claimed in-service disease or
injury and the present disease or injury, service connection
cannot be granted on a direct basis. Hickson v. West, 12
Vet. App. 247, 253 (1999).
PTSD
The Veteran contends that he experienced two particularly
stressful incidents in service that led to his claimed PTSD
disability: riding in the back of a vehicle that struck and
killed a girl in 1968, and "seeing stuff" while unloading
choppers at hospital sites he was constructing. Service
treatment records are entirely silent for any complaints,
findings or reference to any psychiatric disorder, including
PTSD.
The Veteran's claims file contains no evidence that he has a
current PTSD disability, and he testified in November 2008
that he does not have a PTSD diagnosis yet. Therefore, the
Veteran's claim for service connection for PTSD must be
denied because there is no evidence of a current PTSD
disability. See Brammer v. Derwinski, 3 Vet. App. at 225.
All Claims
In addition to the medical evidence, the Board has considered
the assertions that the Veteran and his representative have
advanced in connection with the appeal. The Board does not
doubt the sincerity of the Veteran's belief that he has
hearing loss, tinnitus, arthritis in his hips and knees,
neuropathy of the right and left hand, sleep apnea, and PTSD
as a result of events during military service. However,
questions of medical diagnosis and causation are within the
province of medical professionals. See Jones v. Brown, 7
Vet. App. 134, 137-38 (1994). As the Veteran is a layperson
without the appropriate medical training or expertise, he is
not competent to render probative (i.e., persuasive) opinions
on these medical matters. See Bostain v. West, 11 Vet. App.
124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App.
492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186
(1997) ("a layperson is generally not capable of opining on
matters requiring medical knowledge"). Consequently, the
lay assertions as to the nature or etiology of his claimed
disabilities have no probative value.
For all the foregoing reasons, the claims for service
connection for hearing loss, tinnitus, arthritis of the
bilateral hips and bilateral knees, neuropathy of the right
and left hand, sleep apnea, and PTSD must be denied. In
arriving at the decision to deny the claims, the Board has
considered the applicability of the benefit-of-the-doubt
doctrine. However, as the preponderance of the evidence is
against the claims, that doctrine is not applicable. See 38
U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski,
1 Vet. App. 49, 53-56 (1990).
ORDER
The appeal as to service connection for diabetes mellitus, to
include as secondary to herbicide exposure, is dismissed.
The appeal as to service connection for erectile dysfunction
is dismissed.
Entitlement to service connection for hearing loss is denied.
Entitlement to service connection for tinnitus is denied.
Entitlement to service connection for arthritis of the
bilateral hips is denied.
Entitlement to service connection for arthritis of the
bilateral knees is denied.
Entitlement to service connection for neuropathy of the right
and left hand is denied.
Entitlement to service connection for sleep apnea is denied.
Entitlement to service connection for PTSD is denied.
____________________________________________
RENÉE M. PELLETIER
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs